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The Barbara Ann Karmanos Cancer Institute in Detroit treats thousands of oncology patients each year for serious and often life-threatening medical conditions.

But not too many people consider the inherent environmental dangers to employees, families and patients created by the mixing, administering and treatment of the chemotherapy and hazardous medications.

"We use closed-system transfer devices in the preparation of chemotherapy and hazardous medications that prevents the drug from being aerosolized and exposing hazardous drug compounds" to people in the hospital, said Steve Smith, Karmanos' executive director for pharmacy services.

Smith said with up to 50,000 doses administered each year, the danger is too great of hazardous chemicals floating into the air or sticking on surfaces and coming into contact with the hospital's 60 lab workers and dozens of other people admitted to or visiting the hospital.

Exposure to the vapors, residues and needle jabs from various chemotherapy drugs can cause skin conditions, infertility, birth defects, leukemia and other cancers, said the Centers for Disease Control and Prevention.

Steve Smith

Starting in the early 2000s, Karmanos — and many other cancer centers, pharmacies and oncology medical practices — began to use closed-system mixing devices to reduce exposure and improve occupational and customer safety, Smith said.

"Prior to 2001, we mixed drugs in an IV (intravenous) compounding hood without any containment devices" to transfer the drugs from a vial to a syringe and then into an infusion bag, said Smith. "Technology came into the marketplace that allowed us to contain the drugs."

Smith said Karmanos was one of the first hospitals in the nation to purchase the medical devices that mechanically prevent both the transfer of contaminants into the chemotherapy drugs and prevent vapors or residue from leaving the system.

Over the past four years, Karmanos has been using a device manufactured by EquaShield LLC, a Tefen, Israel-based company with a distribution office in Port Washington, N.Y.

The EquaShield device is a medication vial fitted with an adapter that connects to a specially designed syringe that then, via another adapter, connects to the infusion bag.

"This is part of our program to monitor the environment every six months," Smith said. "We measure in nanograms. There is no scientific data to show how much exposure is dangerous. We want to be careful and are constantly looking for technology that is tight and look to decrease the exposure."

Smith said Karmanos has experienced a 20 percent decrease in costs over the last four years by using the devices. He declined to discuss annual costs.

"Because EquaShield is a more self-contained device, it's easier to use, easier to store and takes less storage, and there is less waste. All of these factors impact efficiencies," Smith said.

Marino Kriheli, inventor of EquaShield and company co-owner, told Crain's EquaShield has several hundred hospital and oncology medical group customers.

Besides Karmanos, hospital customers include the Cleveland Clinic and Mount Sinai Hospital in New York City, Kriheli said.

"Hospitals take special measures to restrict and keep everything safe and enclosed, but you still find traces of drugs in offices and departments, places where these drugs were never used," Kriheli said.

Kriheli said EquaShield has been growing at a 60 percent annual rate since its founding in 2010. Its founding company is Plastmed Ltd., a Tefen, Israel-based medical device maker that Kriheli also co-owns.

The single-use EquaShield medical device costs about $8 per administration. Karmanos spends at least $320,000 to $400,000 for the system, based on its annual 40,000 to 50,000 doses administered.

Kriheli declined to provide an average price for the device.

"Only 20 percent to 30 percent of hospitals that mix hazardous medications used closed systems," he said. "The costs are negligible compared with the risks involved. You have problems and end up (paying out) much higher numbers" when people get sick.